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Insurance Credentialing & Contracting Agent (US Healthcare) | Remote (EST Hrs)

2 weeks, 6 days ago
South Africa
Full-time
Mid Level
Operations Specialist
Operations
Apply Now
ISTA Solutions

ISTA Solutions

ISTA Solutions is a one-stop outsourcing company that provides quality and cost-efficient services and solutions. They offer tailor-made workflow solutions, skilled agents dedicated to clients, global resources for comprehensive support, and a focus on...

Professional Services
251-1K
Founded 2015
View All Jobs 13

Description

  • Manage insurance credentialing for newly hired clinicians and keep insurer portals and documentation updated for compliance and billing accuracy.
  • Research insurance markets in new states and identify which insurers to prioritize for network participation.
  • Contact insurance companies to confirm credentialing requirements, application steps, and reimbursement rate structures.
  • Negotiate reimbursement rates with insurers when offered rates are below competitive benchmarks.
  • Track credentialing and contracting progress and proactively flag delays or issues.
  • Maintain accurate, audit-ready records across multiple insurer portals and systems.
  • Follow established workflows and escalate issues appropriately when needed.
  • Complete ad hoc coordination tasks as assigned.

Requirements

  • U.S. health insurance experience, including private insurers and Medicaid.
  • Excellent communication skills and strong English fluency, both verbal and written.
  • Strong critical thinking and independent problem-solving skills.
  • Confident, proactive approach to initiating contact with insurers and negotiating terms.
  • Highly detail-oriented and organized, with the ability to manage multiple portals and deadlines accurately.
  • Basic computer literacy, including MS Office and Outlook.
  • Ability to work independently with minimal day-to-day supervision.
  • Experience with ABA-specific insurance processes is a strong plus, but not required.
  • Must be able to work Monday to Friday, 15:00 PM to 00:00 AM South African time, with possible daylight saving changes.
  • Must have a fixed fibre internet connection of at least 25 Mbps upload and download with wired Ethernet support.
  • Must have a reliable power backup solution such as solar, inverter, or UPS.

Benefits

  • Fully remote work arrangement.
  • Compensation for South African public holidays in accordance with the BCEA.
  • Opportunity to support a growing U.S.-based healthcare provider.
  • Exposure to multi-state insurance credentialing and contracting work.

Interested in this position?

Apply directly on the company website

Apply Now

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